2010 Hong Kong Reference Framework for Hypertension Care for ...

Module 2Blood Pressure Measurement3. Precautions about blood pressure recording3.1 Recorder’s precautionsi. Read at eye level.ii.iii.iv.Avoid digital preference. The blood pressure reading should becorrected to the nearest 2 mmHg.Choose the correct cuff size (see 2 v).Consistent use of the 4th or 5th Korotkoff sounds for recording (see 2 xii).v. Correct arm positioninga. blood pressure changes 8-10 mmHg for every 10 cm that theantecubital fossa is above or below the heart level.b. arm well supported (diastolic pressure may be raised by as much as10%).vi. Deflate the cuff not too rapidly or too slowly (see 2 x).vii. Avoid venous congestion due to repeated measurement.viii. Adopt a unified standard in recording routinely to avoid variationamong recorders.3.2 Patient’s factorsi. Emotional factors including white coat hypertension: 24-hourambulatory blood pressure monitoring and self BP monitoring at homecan be used to address the white coat effect.ii. Physical exertion: blood pressure will increase during exertion.iii.After exercise, decrease in blood pressure may persist for more thanone hour.iv. After meals: blood pressure may decrease following meals; recordingis not recommended within half an hour of eating.v. Smoking and caffeine: should be avoided within 1-2 hours prior to BPrecording.vi. Alcohol.vii. Temperature extremes.viii. Bladder and bowel distension.ix.Pain.3 HK Reference Framework for Hypertension Care for Adults in Primary Care Settings